Correlational Research On The Changes Of Heart Rate In Total Laparoscopic Hysterectomy And Postoperative Nausea And Vomiting:A Prospective Cohort Study

BackgroundPrevious studies have shown a high incidence of postoperative nausea and vomiting(PONV)among patients who underwent gynecologic laparoscopic surgery.Total laparoscopic hysterectomy,a common gynecological surgery,is also linked with more PONV,which can lead to complications such as dehydration,electrolyte disorder or even aspiration,suture cracking,bleeding and so on.This has greatly restricted enhanced recovery after surgery and significantly reduced the satisfaction of patients,making PONV control and prevention in this population extremely urgent.Although there is a number of risk factors that may result in it,gastrointestinal hypoperfusion has raised considerable concern.The incidence of PONV may be reduced through hemodynamics regulation of anesthesia management and timely improvement of intraoperative gastrointestinal perfusion.As one of the indexes of hemodynamic monitoring during the operation,heart rate could largely determine the cardiac output and then change the perfusion of gastrointestinal tissue,which makes it possible that well-controlled fluctuation of the rate leads to less PONV.However,correlational research on the changes of heart rate and PONV has not been reported so far.ObjectiveTo explore the correlation between the changes of heart rate during total laparoscopic hysterectomy and the incidence of postoperative nausea and vomiting by observing and analyzing,and to explore the practicable threshold of heart rate that may reduce the occurrence of PONV.Methods166 nonsmoking female patients aged from 18 to 65 who underwent laparoscopical hysterectomy with ASA grade I or II participated in this prospective cohort study.Baseline heart rate was measured preoperatively,while heart rate changes were continuously monitored during the operation,and postoperative follow-up was conducted to see if PONV occurred.The part of data processing systematically allocated the threshold according to the absolute or relative change of heart rate,and discussed the relationship between heart rate change and PONV in three steps:threshold analysis(exceeding or not exceeding threshold),area analysis under curve(area of closed area surrounded by heart rate curve and threshold)and multivariate logical regression including recognized risk factors.ResultsAmong the 156 valid data,96 cases(61.5%)had PONV.The drop in heart rate more than 15%below the baseline(OR 4.19;95%CI,2.90-5.47;p=0.000047),20%below the baseline(OR 2.46;95%CI,1.17-3.75;p=0.015)and heart rate less than 55 beats per minute(OR 2.11;95%CI,0.82-3.39;p=0.037)are all associated with more PONV occurrence.A decrease in heart rate of more than 15%below the baseline was still significantly associated with the occurrence of PONV,after multivariate logistic regression analysis.ConclusionThere was a certain correlation between the decrease of heart rate and PONV,in which heart rate decreased by 15%below baseline,20%below baseline,and heart rate less than 55 beats per minute were significantly correlated with more PONV.The heart rate of perioperative patients maintained above 15%below baseline may reduce the incidence of PONV.